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Monthly Archives: October 2015

Arthritic Foot Care

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Definition: Arthritis can affect any of the movable joints in the feet. This can result in foot deformities such as enlarged swollen joints or toes becoming crooked and causing problems when walking in shoes.

Causes: In rheumatoid arthritis, the toes and the forefoot joints are the most commonly affected. These joints can become displaced and deformed and often the muscles and tendons shorten causing the toes to become hammer shaped or clawed. Pain associated with arthritic changes in the feet will vary with the type and duration of the condition. The pain may be acute as in the initial stages of gout, with the affected joints inflamed and swollen. The pain may present with morning stiffness and limited joint movement, which increases on weight-bearing in rheumatoid arthritis. Joint movements may be lost altogether due to bony deformity of the joints with osteoarthritis, resulting in limited movement and pain experienced with normal day to day activities. It is important to recognise that arthritis can affect other areas of the body, which results in poor posture and restricted movements. It is sometimes difficult for the feet to operate correctly as weight-bearing structures that support and propel the body forwards, when some of the key joints such as the hips or shoulders are affected.

Treatment:

CARE FOR YOUR FEET

Correct washing and drying of your feet is vital in maintaining foot health. It is most important to clean well between toes, lifting each toe and thoroughly clearing out any debris. Foot exercises are essential to help keep the joints moving and reduce joint stiffness that can make a person unsteady and liable to fall more easily. Nails should be cut regularly following the natural separation line of the nail plate and not cutting down at the corners. Corns and callouses if painful, can be treated professionally by a Podiatrist and pressure and friction over these areas can be relieved by protective devices such as tubular foam and other paddings. Cushioning soles can be used in all footwear to provide some shock absorption against all hard walking surfaces.

FOOTWEAR

It is important to buy footwear that provides the best advantages in protection, support and foot comfort for you. It is often a good idea to get yourself professionally measured and fitted with suitable footwear at least once a year. Shoes should be lightweight, flexible and allow the air to circulate around the foot. The ideal materials are leather and canvas, however most modern materials are well designed to accommodate feet. A good example of a lightweight shoe that can accommodate foot deformity is the common jogger or running shoe that is easy to put on and secure with laces or velcro straps to suit arthritic fingers. Shoes must have a broad deep toe box that will provide additional comfort and reduce frictional points that can cause corns and callouses. Heel height ideally should not exceed half an inch. Soles should have a non-slip grip pattern. Always choose the right shoe for the job – eg walking, gardening, etc. to protect the arthritic foot and support them during the activity.

HOW TO SEEK PROFESSIONAL ADVICE

It is important to discuss your mobility and foot care problems with your Podiatrist. Our Podiatrist can advise which service or professional support is most appropriate to your needs. Our Podiatrist, after assessing your foot function may recommend orthotics or insoles to help relieve foot pain and discomfort

Osteomyelitis

Osteomyelitis

Osteomyelitis : You may not have heard of it, but osteomyelitis is one of the most frequent foot infections in diabetics, accounting for 10-15% of mild infections and nearly 50% of severe infections. Osteomyelitis is an infection of the bone that is caused by a variety of microbes — most notably staphylococcus aureus. This infection affects roughly two out of every 10,000 people, and is especially prevalent among diabetics, sickle cell anemics, dialysis patients, drug users, the elderly, and people with weakened immune systems.

How Do People Get Osteomyelitis?

There are many ways a person’s bone can become infected, such as:

  • An open fracture, where the bone pierces the skin (evident in 47% of all cases)
  • Pneumonia or a urinary tract infection turns septic and gets into the bloodstream
  • Vascular insufficiency (which is especially a concern for diabetics)
  • A puncture wound that doesn’t heal right (1-6% cases)
  • A minor wound, which leads to blood clotting around the bone and infection
  • A minor wound, which leads to blood clotting around the bone and infection

Symptoms of Osteomyelitis Early symptoms include pain, tenderness, swelling, warmth, and fever. Many people become nauseous, uneasy, and generally ill-feeling. Sometimes pus drainage through the skin is visible. Excessive sweating, chills, swelling of the lower extremities, and limping have also been reported alongside osteomyelitis. A diagnosis can be made by a physician who will look for signs of tenderness and likely order blood tests/cultures. Other diagnostic indicators include needle aspiration, biopsies, and bone scans.

Treatment of Osteomyelitis Until fairly recently, the standard treatment for diabetic foot osteomyelitis was to scrape away infected portions of the bone during the open surgical procedure. However, more doctors are using antibiotics as a first course treatment to cause remission. The antibiotics rid the body of harmful bacteria in the bloodstream that may otherwise re-infect the bone. Aspiration (draining of infection using a needle) and biopsy sampling will ensure you are given the proper type and dose of antibiotics. Splinting or casting may be required to immobilize the infected bone and avoid further injury. In some cases, surgery is still required, but the prognosis is very good when using a combination of surgery and antibiotics. Very rare cases of chronic osteomyelitis may lead to foot amputation or squamous-cell skin cancer. Though rare, prompt medical attention is important when diabetics encounter any signs or symptoms of infection.

Cracked Heels, Callus and Heel Fissures

Dry, cracked heels can not only be unsightly, but can often be source of pain and embarrassment. The good news is that baby smooth heels are achievable with a little elbow grease and help from your podiatrist. Most minor cracked heels are able to be treated at home but for the best results our podiatrist’s can remove the dead skin from your feet in just 30mins leaving them soft, smooth and ready for sandals.

What are cracked heels?

Cracked heels are caused by cracking or splitting of the skin. This splitting may be due to dryness or thickening of the skin (callus). When the skin around the heels becomes thickened or dry, it loses its suppleness and elasticity, and can split under simple pressures such as that from walking. This can lead to unsightly, painful and even bleeding cracked heels. This can further be made worse in people who have a large fatty pad on the sole of their feet, which under pressure requires more elasticity in the skin to expand without cracking.

Causes of Cracked Heels

  • Skin type is often genetic. Some heels get very thick callus but don’t crack where as others have no callus at all but crack badly after a day on the beach.
  • Long standing at work or home, especially on hard floors
  • Increased weight which causes increased pressure on the heels causing callus. With increased weight the heel is also required to expand more and hence can often crack more.
  • Ill fitted shoes or sandals that don’t support the heels from expanding sideways under pressure.
  • Unhygienic circumstances or conditions as well a s fungal infections/tinea
  • Unhealthy, dry scaly skin that can be caused by climate, such as low humidity during dry summers or cold winters
  • Deficiency of vitamins, minerals, zinc and malnutrition.
  • Hormonal Conditions such as thyroid or estrogen imbalances.
  • Circulation problems
  • Diabetes where autonomic neuropathy leads to less sweating and thus less moisture

Note: in the elderly, callused or cracked heels may be a sign of increased pressure and can be a precursor to a bed sore. These cases should be assessed by a podiatrist before commencing any at home treatments

Podiatry Treatments

The quickest way to baby smooth heels is to visit your podiatrist who can safely remove the dead skin leaving you with healthy and flauntable feet. They can also provide you with information on what sort of creams are best for your skin type as well as rule out more serious reasons as to why your skin might be dry and cracking. In addition to cleaning the dead dry skin from your heels for you, your podiatrist may also be able to treat the underlying causes to your cracking as well as giving you the right advice on how to keep your heels in great condition.

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Onychogryphosis (Rams Horn Nails)

 onychogryphosisOnychogryphosis also known as “ram’s horn nails,” is a condition in which the toenails become thickened and the curve of the nails becomes more severe, making them difficult to cut and causing them to grow into a long, curved shape resembling a ram’s horn. The difficulty of trimming the nail is often exacerbated by neglect—one of the very things that sometimes brings the condition about in the first place. For this reason, the elderly are especially prone to onychogryphosis.

Symptoms of Onychogryphosis

To say that the toenail “thickens” does not adequately describe the more severe cases of this condition. In some of these cases the toenail indeed looks more like a horn than a nail; it is yellowish-brown in colour, and no longer flat, so trimming it with nail clippers or scissors is out of the question.

Causes of Onychogryphosis

The most common cause of this kind of nail growth is believed to be chronic neglect. Elderly people in particular can sometimes become absent-minded and indifferent to their health, causing them to become less conscientious about trimming their nails. (In some cases the task of nail trimming may become difficult for us as we get older, due to conditions such as arthritis.)

Another possible cause of onychogryphosis is pressure on the nail over an extended period, such as may be caused by poorly fitted shoes. This pressure causes the toenail to grow unevenly; one side of the nail grows faster than the other.

Other suspected causes of onychogryphosis include:

  • Trauma, such as a blunt-force injury to the toe or a laceration that damages the nail matrix
  • Peripheral Vascular Disease
  • Psoriasis
  • Syphilis
  • Ichthyosis, a skin condition that cause the skin to become dry, cracked, and easily damaged
  • Fungal infection

Complications of Onychogryphosis

If onychogryphosis is left untreated, the nail can eventually grow into the skin, causing pain and inflammation, and creating a risk of bacterial infection. Even if this does not happen, the unchecked growth of the nail can create an environment in which toenail fungus and other sorts of infections can appear.

Treatment of Onychogryphosis

Surgical removal of the toenail (also known as avulsion of the nail plate) is a common treatment for onychogryphosis, and in some cases your podiatrist may even recommend a permanent nail removal, which is accomplished by destroying the nail matrix. (The nail matrix is the layer of cells at the root of the nail responsible for producing keratin, the material the nail is made of. In other words, the matrix creates the nail and causes it to grow.)

The procedure for removing a toenail is simple—the podiatrist injects a local anesthetic into your toe and simply removes the nail. Following the removal of the nail plate, the next step may be the destruction of the nail matrix. This may be necessary if the condition is so severe (or has gone untreated for so long) that the nail matrix has been scarred and this scarring has permanently altered its orientation, making it impossible for the nail to ever grow properly again. A nail that is allowed to grow from a matrix that has been damaged in this way will continue to thicken as before and may not adhere properly to the nail bed.

If your podiatrist has determined that it is necessary to destroy the nail matrix after removing your toenail, he or she will coat the matrix with a chemical agent. This procedure is known as a partial or full matrixectomy, or permanent nail removal.

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